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Do Interventions Work?

Posted Feb 05 2012 9:39pm

It has been a while, it seems, since I’ve checked in. I’m at the point in the life cycle of a ‘blogger’ where I feel like I’ve said most of what I came here to say… so help me out by sending your questions, particularly those with broad implications, and I’ll chime in with an opinion.

In the meantime, check out the ‘ best of’ page; I have links there to some of the more popular post. And for now, I’ll answer a question I received today on ‘ TheFix.com’ :

Do you believe in intervention of someone who does not ask or desire (to be clean)?

It is hard to predict human behavior; sometimes people rise to the occasion when all appears to be lost, and other times people who have everything going their way make surprisingly poor decisions. But in my experience, real sobriety requires the addict to feel a profound need to change that comes from within.

More common than you think!

That doesn’t mean, necessarily, that interventions never work—but the intervention should be set up in such a way that the addict or alcoholic—him or herself– comes to the realization that getting clean is the only option.

For example… let’s say that grandma has a problem with pain pills, taking more than what is prescribed, going to multiple doctors, going to the ER for pain pills, etc. Her children don’t like her behavior, so they stage an intervention, to show her the problems her behavior is causing. At the intervention, they tell her how hurt her grandchildren are by her absence at their functions, and they explain the risks of her behavior. They set her up at a treatment center, and she is shipped off for 30 days.

She may go to all of the groups and meetings in treatment, agreeing politely in every setting that she has a serious problem, and that she really ‘gets it.’ And that would be great for the treatment center; they would collect their $30K, and everyone there would congratulate each other on how compassionate and bright they are. And later, when grandma is doing the exact thing she was doing before treatment, the counselors would put the blame on HER, acting as if SHE has a problem for not sticking to plan—even though almost all of their patients end up the same.

I used to be a bigger fan of residential treatment. But at some point I let go of the fantasy of residential treatment as the ‘gold standard’, and accepted the real numbers. It is easy to clean a person up for a month in a closed environment. But in regard to long-term sobriety… residential treatment rarely works. Sorry to say something so horrible—but that emperor, sadly, has no clothes.

So back to grandma… I would expect her to go back to the same behavior after treatment. Why, after hearing from all the family, would she do that?

Because true change is very, very difficult.

Besides, she has plenty of reasons to keep things the same. She will likely think that the problem isn’t the use of pain pills, but rather that she didn’t hide things well enough. Or she will assume that other people simply don’t understand what it is like to be 70 years old, trying to live with pain. She used to change the smelly diapers of these kids; what could they possibly tell her that she doesn’t know?

And the major reason she won’t change? For her to truly realize that her behavior is a problem, she would have to endure the shame for what was going on—and shame is a very strong motivator for denial.

In treatment, the team will try to try to break through that denial and have her admit, to herself, that she has a problem. But that type of admission is rare, and only comes out when a person is desperate—and when there is no choice but to change.

But there are other ways to manage an intervention. It would be best if grandma herself decides, at some point, that things must change. How does that happen? First, everyone has to stop enabling her. If the grandchildren are angry that grandma didn’t show up at their birthdays, they should be allowed to express that anger—and when grandma protests, she is forced to hear why people are mad. If grandma runs into problems with the doctor or pharmacist, nobody should help her sort things out; she is left to juggle excuses on her own. If she needs the ER for pain pills, she drives herself—or waits for a cab.

I chose ‘grandma,’ by the way, because I wanted to present the challenge of dealing with a person who deserves sympathy. Nobody does her a favor by keeping her miserable. Realize, though, that we are discussing addiction here; I’m not suggesting that people abandon loved ones struggling with painful conditions!

The doctor should prescribe medications on a tight schedule, with strict refill dates that are maintained without exception. Doctors are sometimes afraid to let people go into withdrawal, so they order ‘a few extra pills’ to get to the next refill; medications should be long-lasting, so that withdrawal is uncomfortable, but not dangerous. A short period of the medication- i.e. a one-week supply—will reduce the period of withdrawal. If a person struggles to follow limits, the prescribing period is shortened until the person CAN follow it—even to the point of 3-day prescriptions with multiple refills. If grandma complains about the multiple trips to the pharmacy, she is told that period will be lengthened if she sticks to the schedule— and shortened if she doesn’t.

The point of all of this is to make the person with the problem feel the consequences of their problem. Too often, everyone else is aware of the need for an intervention, because everyone else feels the consequences—everyone but the addict. The trick is to make the consequences hit the person who has the problem—and for everyone else to get on with life, until the person with the problem is sick and tired of those consequences.

Of course, every now and then an intervention turns out to be meaningful enough to get a person’s attention, and to spur change. But in my experience those types of outcomes—the things we see on TV and in movies—are not the norm.